- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,586.77 / $2,024.42 / $2,078.69
| Professional | | $1,586.77 | $2,024.42 | $2,078.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,458.91 / $2,024.42 / $2,024.42
| Professional | | $1,458.91 | $2,024.42 | $2,024.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,217.64 / $2,217.64 / $2,217.64
| Facility | | $2,217.64 | $2,217.64 | $2,217.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,884.99 / $2,217.64 / $2,217.64
| Professional | | $1,884.99 | $2,217.64 | $2,217.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,557.02 / $1,715.36 / $2,427.89
| Professional | | $1,557.02 | $1,715.36 | $2,427.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,018.26 / $1,324.07 / $1,771.62
| Professional | | $1,018.26 | $1,324.07 | $1,771.62 |